Pondering Over PrEP and PEP

This week the Ugandan government rejected the introduction PrEP as an HIV prevention tool in the country on moral grounds, arguing that it encourages ’reckless sex’ (see here) even in spite of a recent study indicating its potential effectiveness. Alex Ario, the programme manager in the Ministry of Health’s AIDS Control Programme deemed it as ‘not right, morally unfit and incorrect’. The move has been described as controversial and has angered many working in HIV prevention in Africa. But what is PrEP and why is its use such a controversial issue?

PrEP is a special course of HIV treatment that aims to prevent people from becoming infected with HIV. It can be prescribed for those who are at high risk of becoming HIV positive, such as serodiscordant couples (where one partner is HIV positive and the other is HIV negative). In this case the HIV negative partner takes antiretroviral medication daily to protect them from infection. In the United States the use of PrEP (marketed as Truvada) was approved in 2012 and this is currently being considered by other countries. In the UK a current PrEP trial (that is recuiting participants) is the PROUD study, which is being carried out in London (and elsewhere) for gay and bisexual men who have had unprotected sex. Mathematical models show that if 90% of the population use PrEP 90% of the time the spread of HIV infection could be reduced by more than 80% (see here). Other studies show similar (but varying) results implying that PrEP could be an important tool in future HIV prevention work. However, the use of PrEP is controversial for some, principally because it has been argued that it could cause gay and bisexual men to engage in more risky behaviour (although studies show little evidence for this) and also because of concerns over possible side effects. Even is PrEP was introduced on a large scale, it would have to be combined with support which seeks to build treatment adherence if it is to be successful at reducing HIV transmission.

PrEP shouldn’t be confused with PEP which is a course of HIV medication that is given to people that are HIV negative and have put themselves at risk of becoming HIV positive. Amongst gay and bisexual men it is most commonly taken by those that are HIV negative and have had unprotected anal sex with someone they know to be positive. It can be accessed from any sexual health clinic or accident and emergency (casualty) hospital department in the UK. The most important thing to remember with PEP is that it must be taken within 72 hours and the sooner it is taken after the risk the more effective it is. It is a month long course of medication that reduces the risk of HIV transmission, although it can have side effects such as headaches, diarrhea and nightmares.

You have 72 hours in which to take PEP

Together PEP and PrEP represent biomedical approaches to HIV prevention. Other methods which take a non-biomedical method are those focusing on behaviour, such as counselling, mentoring and one-to-one sessions with health advisors. Together, these talking therapies are an important aspect of HIV prevention which can focus on complicated issues that impact human sexual behaviour, such as self-esteem, relationships, drugs, alcohol, identity and so forth. The GMI Partnership focuses on free behavioural focused support for gay and bisexual men in London. For more information please see our website or contact tony@metrocentreonlne.org.

What do you think about PEP and PrEP? Would you participate in a trial for PrEP personally? Do you think that using treatment as prevention is a controversial approach to HIV prevention?

The views in the article are those of the author and do not necessarily represent those of the GMI Partnership.